雙能量CT對腎上腺轉(zhuǎn)移瘤及原發(fā)腺瘤鑒別診斷的應(yīng)用研究
發(fā)布時間：2019-04-21 20:05
【摘要】：背景和目的 在放射科日常診斷腎上腺病變的工作中,最常遇到的就是腎上腺腺瘤和轉(zhuǎn)移瘤的鑒別診斷,明確的診斷會對腫瘤分期、治療、預(yù)后等產(chǎn)生重要影響。以往的CT是單參數(shù)成像,無法提供更多病變信息；而雙能量CT是近年來新興的成像模式,可以通過特殊的能譜成像技術(shù)提供病變的組成信息,具有基物質(zhì)定量分析、能譜分析等功能,目前已經(jīng)初步應(yīng)用在腫瘤的鑒別診斷方面。本研究的目的是對腎上腺腺瘤及轉(zhuǎn)移瘤采用常規(guī)CT平掃及雙能量增強雙期掃描,分析腎上腺腺瘤及轉(zhuǎn)移瘤的一般影像學(xué)表現(xiàn),并分析二者的能譜參數(shù)特征,以判定能譜成像技術(shù)對鑒別腎上腺腺瘤與轉(zhuǎn)移瘤的價值。 資料和方法 35例患者(男16例,女19例,年齡范圍30-76歲,平均年齡52.2±12.7歲),40個病灶(腺瘤24個,轉(zhuǎn)移瘤16個)入組分析。以平掃CT值10HU為標(biāo)準(zhǔn)將24個腺瘤病灶,分為富脂腺瘤組(14個病灶,CT值≤10HU)和乏脂腺瘤組(10個病灶,CT值10HU),分別與轉(zhuǎn)移瘤進行統(tǒng)計分析,以明確各參數(shù)對富脂腺瘤與轉(zhuǎn)移瘤及乏脂腺瘤與轉(zhuǎn)移瘤鑒別診斷的意義。對病變的以下特征：①病人的年齡、腫瘤的大小(最大徑線)、腫瘤平掃的CT值、增強CT值、腫瘤與臨近組織的分界、是否存在鈣化、囊變、壞死等；②碘基值、水基值、脂肪-碘基值進行統(tǒng)計分析。根據(jù)受試者工作特征曲線(receive operating characteristic curve, ROC)計算各參數(shù)閾值,以確定敏感度、特異度及約登指數(shù)。 結(jié)果 35例患者40個病灶,其中腺瘤24個(富脂腺瘤14個,乏脂腺瘤10個),轉(zhuǎn)移瘤16個。富脂腺瘤、乏脂腺瘤與轉(zhuǎn)移瘤的平均大小、發(fā)病年齡及性別組成比等常規(guī)參數(shù)均沒有統(tǒng)計學(xué)差異。腎上腺富脂腺瘤組平掃CT值較轉(zhuǎn)移瘤略低,差異存在統(tǒng)計學(xué)意義,而乏脂腺瘤CT值較轉(zhuǎn)移瘤略高,差異沒有統(tǒng)計學(xué)意義。能譜雙期增強掃描,富脂腺瘤、乏脂腺瘤的水基值、脂肪-碘基值均低于轉(zhuǎn)移瘤,差異有統(tǒng)計學(xué)意義。以ROC曲線分析雙期能譜參數(shù)結(jié)果,動脈期的鑒別意義最大,敏感度和特異度均較高。對比動脈期各能譜參數(shù)結(jié)果,水基值的敏感度較高,但脂肪-碘基值的特異度較高。 結(jié)論 雙能量CT能譜成像可以在增強掃描時提高鑒別腎上腺富脂腺瘤與轉(zhuǎn)移瘤、乏脂腺瘤與轉(zhuǎn)移瘤的診斷敏感度與特異度。其中WCad和FCad對診斷鑒別診斷有幫助較大,能鑒別常規(guī)CT平掃和多期增強較難鑒別的腎上腺乏脂腺瘤與轉(zhuǎn)移瘤,并能明顯提高乏脂腺瘤與轉(zhuǎn)移瘤鑒別診斷的敏感度和特異度,為指導(dǎo)臨床工作提供幫助。
[Abstract]:Background and objective in the routine diagnosis of adrenal lesions in radiology, the differential diagnosis of adrenal adenomas and metastatic tumors is the most common one. Definite diagnosis will have an important impact on the staging, treatment and prognosis of adrenal tumors. In the past, CT was single parameter imaging and could not provide more information of pathological changes. Dual-energy CT is a new imaging mode in recent years. It can provide information about the components of lesions through special energy spectrum imaging technology. It has the functions of quantitative analysis of basic substances and energy spectrum analysis. It has been applied to differential diagnosis of tumors at present. The purpose of this study was to analyze the general imaging features of adrenal adenomas and metastatic tumors by conventional CT plain scan and dual-energy enhanced dual-phase scanning, and to analyze the characteristics of energy spectrum parameters of the two types of adrenal adenomas and metastatic tumors. To determine the value of energy spectrum imaging in differentiating adrenal adenoma from metastatic tumor. Materials and methods 35 patients (M 16, F 19, mean age 52.2 鹵12.7 years) with 40 lesions (24 adenomas and 16 metastatic tumors) were analyzed. According to CT value 10HU, 24 adenoma lesions were divided into fat-rich adenomas group (14 lesions, CT value = 10 Hu) and anadiomatous adenomas group (10 lesions, CT value 10HU), and analyzed statistically with metastatic tumors. To determine the significance of each parameter in differential diagnosis between fat-rich adenoma and metastatic tumor and anasteinoma from metastatic tumor. The features of the lesions were as follows: (1) the age of the patient, the size of the tumor (maximum diameter line), the CT value of the plain scan of the tumor, the enhanced CT value, the boundary between the tumor and the adjacent tissue, whether there were calcification, cystic change, necrosis, etc. 2 iodine base value, water base value and fat-iodine base value were analyzed statistically. The threshold values of each parameter were calculated according to the receiver operating characteristic curve (receive operating characteristic curve, ROC) to determine the sensitivity, specificity and Joden index. Results there were 40 lesions in 35 patients, including 24 adenomas (14 fat-rich adenomas, 10 fat-deficient adenomas) and 16 metastatic tumors. There was no statistical difference in the average size, age of onset and sex ratio between fat-rich adenoma, asthenoma and metastatic tumor. The CT value of adrenal sebaceous adenoma group was slightly lower than that of metastatic tumor, and the CT value of anadipose adenoma was slightly higher than that of metastatic tumor, and the difference was not statistically significant. The water base value and fat-iodine base value of fat-rich adenoma and asthenoma were lower than those of metastatic tumor by energy spectrum dual-phase enhanced scanning, and the difference was statistically significant. The biphasic energy spectrum parameters were analyzed by ROC curve, the differentiation of arterial phase was the most significant, and the sensitivity and specificity were higher. The sensitivity of water-based value was higher than that of fat-iodine value, but the specificity of fat-iodine value was higher than that of arterial phase. Conclusion dual-energy CT energy spectrum imaging can improve the sensitivity and specificity of differential diagnosis between adrenal fat-rich adenoma and metastatic adenoma, anadiomatous adenoma and metastatic tumor in contrast-enhanced scanning. Among them, WCad and FCad are of great help in differential diagnosis. They can distinguish adrenal adenoma from metastatic adenoma which is difficult to distinguish by conventional CT plain scan and multi-phase enhancement, and can significantly improve the sensitivity and specificity of differential diagnosis between adipocytic adenoma and metastatic tumor. Provide help to guide clinical work.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R736.6;R730.44
本文編號：2462512
[Abstract]:Background and objective in the routine diagnosis of adrenal lesions in radiology, the differential diagnosis of adrenal adenomas and metastatic tumors is the most common one. Definite diagnosis will have an important impact on the staging, treatment and prognosis of adrenal tumors. In the past, CT was single parameter imaging and could not provide more information of pathological changes. Dual-energy CT is a new imaging mode in recent years. It can provide information about the components of lesions through special energy spectrum imaging technology. It has the functions of quantitative analysis of basic substances and energy spectrum analysis. It has been applied to differential diagnosis of tumors at present. The purpose of this study was to analyze the general imaging features of adrenal adenomas and metastatic tumors by conventional CT plain scan and dual-energy enhanced dual-phase scanning, and to analyze the characteristics of energy spectrum parameters of the two types of adrenal adenomas and metastatic tumors. To determine the value of energy spectrum imaging in differentiating adrenal adenoma from metastatic tumor. Materials and methods 35 patients (M 16, F 19, mean age 52.2 鹵12.7 years) with 40 lesions (24 adenomas and 16 metastatic tumors) were analyzed. According to CT value 10HU, 24 adenoma lesions were divided into fat-rich adenomas group (14 lesions, CT value = 10 Hu) and anadiomatous adenomas group (10 lesions, CT value 10HU), and analyzed statistically with metastatic tumors. To determine the significance of each parameter in differential diagnosis between fat-rich adenoma and metastatic tumor and anasteinoma from metastatic tumor. The features of the lesions were as follows: (1) the age of the patient, the size of the tumor (maximum diameter line), the CT value of the plain scan of the tumor, the enhanced CT value, the boundary between the tumor and the adjacent tissue, whether there were calcification, cystic change, necrosis, etc. 2 iodine base value, water base value and fat-iodine base value were analyzed statistically. The threshold values of each parameter were calculated according to the receiver operating characteristic curve (receive operating characteristic curve, ROC) to determine the sensitivity, specificity and Joden index. Results there were 40 lesions in 35 patients, including 24 adenomas (14 fat-rich adenomas, 10 fat-deficient adenomas) and 16 metastatic tumors. There was no statistical difference in the average size, age of onset and sex ratio between fat-rich adenoma, asthenoma and metastatic tumor. The CT value of adrenal sebaceous adenoma group was slightly lower than that of metastatic tumor, and the CT value of anadipose adenoma was slightly higher than that of metastatic tumor, and the difference was not statistically significant. The water base value and fat-iodine base value of fat-rich adenoma and asthenoma were lower than those of metastatic tumor by energy spectrum dual-phase enhanced scanning, and the difference was statistically significant. The biphasic energy spectrum parameters were analyzed by ROC curve, the differentiation of arterial phase was the most significant, and the sensitivity and specificity were higher. The sensitivity of water-based value was higher than that of fat-iodine value, but the specificity of fat-iodine value was higher than that of arterial phase. Conclusion dual-energy CT energy spectrum imaging can improve the sensitivity and specificity of differential diagnosis between adrenal fat-rich adenoma and metastatic adenoma, anadiomatous adenoma and metastatic tumor in contrast-enhanced scanning. Among them, WCad and FCad are of great help in differential diagnosis. They can distinguish adrenal adenoma from metastatic adenoma which is difficult to distinguish by conventional CT plain scan and multi-phase enhancement, and can significantly improve the sensitivity and specificity of differential diagnosis between adipocytic adenoma and metastatic tumor. Provide help to guide clinical work.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R736.6;R730.44
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